Form 1C-P-963 "Ex Parte Motion to Waive Filing Fees and Surcharges Under Hawai'i Revised Statutes Chapter 607 and Declaration; Order" - Hawaii

What Is Form 1C-P-963?

This is a legal form that was released by the Hawaii Circuit Court - a government authority operating within Hawaii. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 2019;
  • The latest edition provided by the Hawaii Circuit Court;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of Form 1C-P-963 by clicking the link below or browse more documents and templates provided by the Hawaii Circuit Court.

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Download Form 1C-P-963 "Ex Parte Motion to Waive Filing Fees and Surcharges Under Hawai'i Revised Statutes Chapter 607 and Declaration; Order" - Hawaii

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Name: ______________________________________
Address: _______________________________________
Telephone No: ________________________________
Plaintiff / Petitioner Pro Se
IN THE CIRCUIT COURT OF THE FIRST CIRCUIT
STATE OF HAWAIʻI
)
No.
)
EX PARTE MOTION TO WAIVE
)
Plaintiff/Petitioner,
FILING FEES AND SURCHARGES
)
UNDER HAWAIʻI REVISED STATUTES
)
vs.
CHAPTER 607 AND
)
DECLARATION; ORDER
)
)
Defendant/Respondent. )
)
EX PARTE MOTION TO WAIVE FILING FEES AND SURCHARGES
UNDER HAWAIʻI REVISED STATUTES CHAPTER 607 AND DECLARATION
Petitioner in the above-entitled action submits his/her motion to waive the filing fees and,
surcharges, required by HRS Chapter 607, and says that:
1. Because of my poverty, I am unable to pay the filing fees and I believe I am entitled to
relief.
2. My gross monthly income from all sources is $
. I receive money from:
(check all that apply)
a. [
]
job:
$
b. [
]
welfare:
$
c. [
]
food stamps:
$
d. [
]
unemployment benefits: $
e. [
]
social security:
$
f.
[
]
child support:
$
g. [
]
part-time or side jobs:
$
h. [
]
other:
$
1C-P-963
RG-AC-508 (7/19)
Name: ______________________________________
Address: _______________________________________
Telephone No: ________________________________
Plaintiff / Petitioner Pro Se
IN THE CIRCUIT COURT OF THE FIRST CIRCUIT
STATE OF HAWAIʻI
)
No.
)
EX PARTE MOTION TO WAIVE
)
Plaintiff/Petitioner,
FILING FEES AND SURCHARGES
)
UNDER HAWAIʻI REVISED STATUTES
)
vs.
CHAPTER 607 AND
)
DECLARATION; ORDER
)
)
Defendant/Respondent. )
)
EX PARTE MOTION TO WAIVE FILING FEES AND SURCHARGES
UNDER HAWAIʻI REVISED STATUTES CHAPTER 607 AND DECLARATION
Petitioner in the above-entitled action submits his/her motion to waive the filing fees and,
surcharges, required by HRS Chapter 607, and says that:
1. Because of my poverty, I am unable to pay the filing fees and I believe I am entitled to
relief.
2. My gross monthly income from all sources is $
. I receive money from:
(check all that apply)
a. [
]
job:
$
b. [
]
welfare:
$
c. [
]
food stamps:
$
d. [
]
unemployment benefits: $
e. [
]
social security:
$
f.
[
]
child support:
$
g. [
]
part-time or side jobs:
$
h. [
]
other:
$
1C-P-963
RG-AC-508 (7/19)
3. I help to support
(fill in #) dependents in my household, not including myself.
4. Within the past twelve months, I received money from the following sources:
(check box and circle all that apply)
a. [
] business, profession or form of self-employment
$
b. [
] rent payments, interest or dividends
$
c. [
] pensions, investments, annuities, or life insurance payments
$
.
d. [
] gifts or inheritances
$
e. [
] disability payments, lawsuit damages, etc.
$
f.
[
] other:
$
5. My total assets (including but not limited to cash, bank accounts, real estate, stocks,
bonds, cars, etc.) are $
.
6. I own the following:
(check box and circle all that apply)
a. [
] house, townhouse, condo, other real property worth
$
b. [
] pager, cellular phone, computer worth
$
c. [
] jewelry worth
$
d. [
] firearms, collectibles, sports equipment, etc. worth
$
e. [
] car, van, truck, motorcycle, boat, etc. worth
$
7. I have a total amount of debts $
, owed on the following:
a. mortgage
$
b. credit cards
$
c. loans
$
d. other:
$
I declare under penalty of perjury that the foregoing is true and correct.
DATED: Honolulu, Hawaiʻi:
.
Plaintiff / Petitioner
WAIVER OF FILING FEES AND SURCHARGES APPROVED AND SO ORDERED
SUBJECT TO REIMBURSEMENT UPON ORDER OF THE COURT:
Judge of the Above-Entitled Court
1C-P-963
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